Medical Screening in the Workplace: Proposed Principles

The implementation of medical monitoring programs following potentially hazardous exposures: a medico-legal perspective

“…Tests used for medical monitoring should be sensitive, specific, precise, rapid, easy, inexpensive, and involve, at most, minimal risk. The positive predictive value of the test should be calculated based on the anticipated prevalence of disease in the monitored population to determine whether the costs and risks of monitoring are reasonable and whether a net benefit is anticipated to accrue to the monitored population [6]. In developing a medical monitoring program for former workers at the US Department of Energy weapons sites and national laboratories, monitoring for a "particular exposure-induced health outcome" was only considered if two criteria were met:…”

“…These two approaches, both designed for former US Department of Energy workers, demonstrate two diametrically opposite approaches to medical monitoring. The use of tests and test panels (e.g., liver function panel) without a scientifically sound and evidence-based rationale increases the risk that results will be abnormal due to chance alone [6]. Further investigation (e.g., invasive confirmatory testing) of these abnormal results may then lead to greater risk and increased costs.…”

“…Therefore, a risk-benefit analysis should be undertaken for each test proposed for a medical monitoring program. Monitoring programs should be regularly reassessed to determine whether the monitoring is consistent with interval changes in medical and scientific knowledge [6].…”

Surveillance in occupational illness and injury: concepts and content.

“…In occupational health, the term "screening" should be used to describe programs that include a medical history, physical examination, and laboratory tests to detect a specific disease process at an early, potentially reversible stage. 5 Efficacy of case identification surveillance programs is best described by quantification of the benefit to the individual case, his or her co-workers, or improvements in the work environment. These benefits can be considered using traditional prevention concepts.…”

Surveillance for the Effects of Workplace Exposure

“…The precepts suggested by Wilson & Junger are presented in parallel with revised precepts for screening for the effects of occupational exposure ( Table I). A fuller treatment of these precepts can be fo und in (30).…”